Publication: Dorsal Longitudinal T-Myelotomy (Bischof II Technique): A Useful, Antiquated Procedure for the Treatment of Intractable Spastic Paraplegia
Issued Date
2018-08-01
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ISSN
18788769
18788750
18788750
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2-s2.0-85048553442
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Mahidol University
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SCOPUS
Bibliographic Citation
World Neurosurgery. Vol.116, (2018), e476-e484
Suggested Citation
Bunpot Sitthinamsuwan, Inthira Khampalikit, Luckchai Phonwijit, Akkapong Nitising, Sarun Nunta-aree, Sirilak Suksompong Dorsal Longitudinal T-Myelotomy (Bischof II Technique): A Useful, Antiquated Procedure for the Treatment of Intractable Spastic Paraplegia. World Neurosurgery. Vol.116, (2018), e476-e484. doi:10.1016/j.wneu.2018.05.008 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/46450
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Title
Dorsal Longitudinal T-Myelotomy (Bischof II Technique): A Useful, Antiquated Procedure for the Treatment of Intractable Spastic Paraplegia
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Abstract
© 2018 Elsevier Inc. Objective: Dorsal longitudinal T-myelotomy is a long-established operation to treat severe spastic paraplegia. The present study aimed to report this surgical technique and investigate the efficacy of T-myelotomy for spasticity relief. Methods: All cases undergoing T-myelotomy for treatment of intractable spastic paraplegia during 2009–2017 were included. The severity of spasticity was evaluated with the Modified Ashworth Scale, Penn Spasm Frequency Scale, Adductor Tone Rating Scale, degree of passive range of motion, and occurrence of abdominal muscle spasms. Other clinical assessments included deep tendon reflex assessed by the National Institute of Neurological Disorders and Stroke scale, Babinski sign, healing of decubitus ulcers, and ambulatory status. Results: Fourteen patients with a mean age of 39.3 ± 13.4 years were included. The 7 patients with abdominal muscle spasms before surgery had no spasms after surgery. The Babinski sign was absent in all cases after surgery. Unhealed pressure ulcers in all 9 cases were healed after surgery. All 4 patients with a preoperative bed-bound condition were able to ambulate with a wheelchair. A statistically significant improvement in mean Modified Ashworth Scale score, degree of passive range of motion, and National Institute of Neurological Disorders and Stroke scale score was found in the subgroup and overall analyses. There was also a statistically significant improvement in the Penn Spasm Frequency Scale and Adductor Tone Rating Scale scores. Conclusions: Dorsal longitudinal T-myelotomy remains an effective option for the treatment of intractable spastic paraplegia. It is suitable for, and may be an alternative to, intrathecal baclofen therapy for patients with complete spinal cord lesion or patients without hope of regaining motor function.